Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma

Abstract

INTRODUCTION Laparoscopic colorectal surgery has gained widespread acceptance. While many studies have compared laparoscopic and open left-sided resections, there is limited literature on right colonic resections. We aimed to analyse the short-term outcome of laparoscopic (LRH) and open right hemicolectomy (ORH) in our unit. METHODS Consecutive patients undergoing elective right hemicolectomies over a period of 28 months were included in the study. No selection criteria were used to allocate the surgical approach. Study parameters included surgical technique, demographic details, ASA grade, body mass index (BMI), length of hospital stay (LOS), post-operative mortality and morbidity, readmission rate and histopathological data. RESULTS A total of 164 patients underwent right hemicolectomies during the study period (LRH: 89, ORH: 75). Both groups were comparable in age, sex, BMI, ASA grade, tumour stage and lymph node harvest. Four patients (4.5%) in the laparoscopic group required conversion to open surgery. In resections with curative intent, microscopic margins were positive in two patients (3%) in the ORH group compared to one (1%) in the LRH group. Seven ORH patients had an adverse post-operative outcome (three anastomotic leaks, four deaths); there were no deaths/immediate complications in the LRH group (p<0.05). The median LOS for LRH patients (4 days, range: 2–21 days) was significantly shorter than for ORH patients (8 days, range: 3–38 days) (p<0.0001, Mann–Whitney U test). By day 5, 77% of LRH patients were discharged compared with only 21% of patients in the ORH group. There were two readmissions (2.7%) in the ORH group and nine (10.1%) in the LRH group. CONCLUSIONS Our findings demonstrate advantages in favour of LRH in terms of a shorter hospital stay and reduced post-operative major complications. LRH is safe and should therefore be available to all patients requiring colonic resection.

Laparoscopic vs. Open Right Hemicolectomies: Short Term Outcomes within an Enhanced Recovery After Surgery Programme

“…This can worsen dehydration and prolong post op ileus [32,33]. Our results are similar to Khan et al [34]. The median length of stay in their study following a laparoscopic procedure was 4 days compared to 8 days for an open procedure.…”

“…One death occurred following pneumonia, again in an ASA III patient. The overall anastomotic leak rate (2.9%) and 30-day mortality (2.9%) is comparable to larger series [39,40,3,34,41,35]. Both patients who had an anastomotic leak were re-operated and were eventually discharged home.…”

Mast Cell Positivity to Tryptase Correlates with Metastatic Lymph Nodes in Gastrointestinal Cancer Patients Treated Surgically

“…A total of 41 gastrointestinal cancer patients diagnosed with preoperative intestinal and gastric endoscopy underwent curative resection. Various surgical approaches have been used: left and right open hemicolectomy for colon cancer; open anterior resection; total mesorectal excision and open abdominoperineal resection for rectal cancer, and open total gastrectomy with D2 lymph node dissection for gastric cancer [16,17,18,19,20]. Patients were staged according to the 7th edition of the AJCC-TNM classification [13,14,15].…”

Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies

“…4 One sixtyfour patients (78 male) underwent an elective right-sided colonic resection. Eighty-nine patients (54%) were in the LRH and seventy-five in the ORH group.…”

“…The reasons could be because of variable and complex anatomy on right side with different procedures like right, extended right hemicolectomy and transverse colectomy. 4 The number of harvested lymph nodes (LNs) required to allow accurate staging after resective surgery for colorectal cancer remains a matter of controversy. 5 Lymph node resection carries with it prognostic and therapeutic implications.…”